Loadcentral Retailer Application Form

Last Name : 

First Name : 

Middle Initial : 

Your Email : 

Home Address : 

City : 

Province : 

Home Number : 

Business Information

Company / Business Name : 

Business Address : 

City : 

Province : 

Contact Number : 

Account Information

Mobile Number to Register / Username : 

Initial Load : 

Birthday : 

Birth Place : 

Referred by : 

For me to access the LoadCentral Web Tool, Uniwiz Trade Sales, Inc. will define my Internet Protocol (I.P.) in the LoadCentral system as:

 Any IP (This means you can access loadcentral.net from any computer)

 Current IP (This means you can access loadcentral.net only on this computer)

I agree as a retailer of Loadcentral that Uniwiz Trade Sales, Inc. and or Oficiar.com will not be held liable in case of Mishandling, Security Breach and Data Manipulation of my account. That I accept full responsibility and control of my account.

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